The Association Between Peri-Operative Quality and Patient Outcomes in Liver Transplant.

Abstract

Background: Peri-operative quality metrics are routinely benchmarked across a wide array of surgical disciplines. However, there is currently no national benchmarking of peri-operative quality measures in liver transplant (LTX). The aim of this study was to assess the association between peri-operative quality metrics and patient outcomes in LTX programs. Methods: This was a cross-sectional analysis of a cohort of US LTX programs. A database was created by integrating peri-operative quality metrics from UHC with donor/recipient characteristics and outcomes from SRTR. These were linked using data aggregated at the LTX center level. Correlation and prediction assessments were conducted through regression and ROC analyses. Results: 3,983 transplants from 68 programs were included, representing 65% of transplants and 52% of LTX programs in the US in 2011. Of 8 peri-operative quality metrics, 4 (LOS, complications, safety events, mortality index) demonstrated significant association with SRTR observed-to-expected (O/E) event rates. A composite of these quality metrics was highly correlated with O/E rates (R2=0.41, p<0.001; figure bottom right). This composite quality index, when adjusted for donor/recipient risk, was capable of predicting LTX programs that were SRTR cited for higher than expected graft loss or death (C-stat 0.95, p<0.001; figure bottom right) with a high degree of sensitivity and specificity (PPV 84%, NPV 94%). The table displays outcomes between high and low peri-operative quality centers and demonstrating significant differences in quality metrics, costs and patient/graft survival. Conclusion: Peri-operative quality measures are highly correlated with patient/graft survival and can accurately predict transplant programs likely to be cited by the SRTR for underperformance. These easily measured and benchmarked quality metrics may be utilized by programs to track and improve peri-operative value potentially leading to improved patient outcomes and reduced risk of being cited as an underperforming center.Table: No Caption available.